| Source: |
Marei, O, Podlasek, A, Soo, E, Butt, W, Gory, B, Nguyen, T N, Appleton, J P, Richard, S, Rice, H, de Villiers, L, Carraro do Nascimento, V, Domitrovic, L, McConachie, N, Lenthall, R, Nair, S, Malik, L, Panesar, J, Krishnan, K, Bhogal, P, Dineen, R A, England, T J, Campbell, B C V & Dhillon, P S 2025, 'Safety and efficacy of adjunctive intra-arterial antithrombotic therapy during endovascular thrombectomy for acute ischemic stroke : a systematic review and meta-analysis', Journal of Neurointerventional Surgery, vol. 17, no. e2, pp. e237-e244. https://doi.org/10.1136/jnis-2023-021244 |
| Description: |
Background : Half of patients who achieve successful recanalization following endovascular thrombectomy (EVT) for acute ischemic stroke experience poor functional outcome. We aim to investigate whether the use of adjunctive intra-arterial antithrombotic therapy (AAT) during EVT is safe and efficacious compared with standard therapy (ST) of EVT with or without prior intravenous thrombolysis. Methods : Electronic databases were searched (PubMed/MEDLINE, Embase, Cochrane Library) from 2010 until October 2023. Data were pooled using a random-effects model and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using ROBINS-I and ROB-2. The primary outcome was functional independence (modified Rankin Scale (mRS) 0–2) at 3 months. Secondary outcomes were successful recanalization (modified Thrombolysis In Cerebral Infarction (TICI) 2b-3), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Results : 41 randomized and non-randomized studies met the eligibility criteria. Overall, 15 316 patients were included; 3296 patients were treated with AAT during EVT and 12 020 were treated with ST alone. Compared with ST, patients treated with AAT demonstrated higher odds of functional independence (46.5% AAT vs 42.6% ST; OR 1.22, 95% CI 1.07 to 1.40, P=0.004, I 2 =48%) and a lower likelihood of 90-day mortality (OR 0.71, 95% CI 0.61 to 0.83, P |